The Office of Personnel Management (OPM) administers the Civil Service
Retirement System (Chapter 83, of title 5, U.S. Code) and Federal Employees'
Retirement System (Chapter 84 title 5, U.S. Code). The information requested on
the enclosed form is needed to document a retirement benefit or claim. The
information may be shared and is subject to verification, via paper, electronic
media, or through the use of computer matching programs, with national, state,
local or other charitable or Social Security Administrative agencies in order
to determine benefits under their programs, to obtain information necessary for
determination or continuation of benefits from OPM, or to report income for tax
purposes. It may also be shared and verified, as noted above, with law
enforcement agencies when they are investigating a violation or potential
violation of civil or criminal law. Executive Order 9397 (November 22, 1943)
authorizes use of the Social Security Number to distinquish between the
applicant and people with similar names. Failure to supply all the requested
information may delay or prevent action on the benefit or claim. Intentionally
false statements and/or suspected illegal activities are reportable by us to
appropriate law enforcement agencies.
We think it takes an average of 12 minutes to complete your certification. Send
comments regarding our estimate or any other aspect of this form, including
suggestions for reducing completion time, to the U.S. Office of Personnel
Management, OPM Forms Officer (3206-0032), Washington, D.C. 20415-7900. The OMB
Number, 3206-0032, is currently valid. OPM may not collect this information,
and you are not required to respond, unless this number is displayed.